GP Petition to Jeremy Hunt to save Lewisham Acute Services

PETITION TO SECRETARY OF STATE FOR
HEALTH

We, GPs in Lewisham and the other boroughs of
SE London, are dismayed by the recommendation in
the Trust Special Administrator’s final report to downgrade
emergency services at Lewisham Hospital. We urge you to reject this
recommendation (No 5), and instead leave distribution of emergency and elective
services in Lewisham and Greenwich to be decided by agreement between local
commissioners and the future merged Lewisham/ Greenwich trust subject to a sustainable
financial solution.

The TSA has ignored overwhelming opposition
from the people and from us, local clinicians who should be guiding the shape
of local services under the reforms your government have enacted([i]). However,
we are heartened that you have said in Parliament this week that no changes
will take place without clear clinical local support. You have also re-iterated
the pledge previously made by the PM that proposals will be subjected to the
four tests for a reconfiguration.

The
four tests are not met

The four tests must be met for Lewisham,
since the attempted service reconfiguration in this report adversely affects
access to emergency services for Lewisham residents only. The Clinical
Commissioning Groups (CCGs) of Dartford and the other five SE London boroughs,
who represent populations whose emergency and elective services are unscathed
by this review, could not be expected to have due consideration or make a valid
judgement on the effect of the proposals on the population of a different
borough. It is therefore deeply disingenuous to imply, as the TSA has done,
that support from SE London and Dartford for the report in its entirety implies
a valid mandate to withdraw services from Lewisham.

Test
1: The report does not have support from GP commissioners

Over 1,000 GPs and healthcare professionals
from across SE London have opposed the proposals ([ii]), including the
Chair (Dr Helen Tattersfield) and all clinical directors and neighbourhood lead
GPs of the Lewisham CCG itself ([iii]).
Of Lewisham’s GPs, two-thirds have signed a petition opposing it ([iv]),
with none in favour. The TSA has claimed the support of the remaining CCGs in
SE London, selectively quoting their responses – which have understandably not
focused on the effects on Lewisham, concentrating on their own local services.
This prescriptive approach that has been taken by the TSA – where local
commissioners have no say in the location of emergency services – is not
consistent with this test.

Test
2: The patient and public engagement has been flawed

The Lewisham proposals do not have public
support in Lewisham, as the public demonstrations ([v]) and the public
petition ([vi])
organised by the three Lewisham MPs have shown.

The Ipsos MORI consultation performed by the
TSA’s office itself shows over 94% of Lewisham residents are strongly opposed
to the loss of the A&E. 50% of respondents in each of the 6 boroughs were
opposed to closure of Lewisham’s A&E. The TSA claims to have met this test
on the basis that the process took place (Appendix
I), although its outcome showed opposition which in the Lewisham
public events was vocal and hostile. We note public criticism of the way these consultation events were run.

The TSA has published recommendation
for paediatric services in Lewisham which have appeared for the first time in
the final report. Therefore there was no opportunity for scrutiny or comment. These
new proposals would close the excellent Lewisham paediatric A&E and set up
a paediatric urgent care centre, a model which is collapsing at Queen Mary’s
Sidcup. No analysis of services and no modelling of proposals were in the
consultation. The impact of fragmentation of care on safeguarding of children
was not discussed.

Similarly, a completely new
maternity option, disallowed for discussion during consultation, has appeared
in the TSA’s final report: the proposed midwifery-led unit in Lewisham has not
been consulted on. It is inherently unsafe for the deprived and ethnically
diverse local population, which has a high and rising birth-rate with a high
proportion of high-risk pregnancies who often present late in pregnancy for
antenatal care.

The Health & Equality
Impact Assessment was not completed before the consultation.

Test
3: The recommendations are not based on sound clinical evidence

The TSA has referred to clinical evidence
which supports centralisation of major trauma, heart attack and stroke in
specialist centres, which is well-established and is not in dispute. However, the
report extrapolates this to claim that better outcomes can be achieved by
centralisation of all other emergency medical, surgical and paediatric conditions.

This is false. There is no clinical evidence
for this. Subject to clinical quality standards being met, high-quality care can
be provided locally in a high-performing hospital for emergencies (other than
stroke, heart attack and major trauma) which account for over 90% of all
emergencies, particularly in the frail ill elderly population and children for
whom local care is particularly important.

No institution in
London meets the new emergency standards in full, but Lewisham, like other
providers, is currently planning to implement these. The fact that these are not yet implemented
is not grounds to suggest that acute services should be withdrawn.

Clinical panels and workshops were
held by the TSA’s office and its management consultants.
In these, medical models from around the world and the UK were discussed, and used
to build an assumption that, if all the benefits were achieved at the same
time, the local health economy would be transformed in five years. This was
rapidly used to justify the claim that emerged early on that one major acute
admitting hospital could be taken out. This became non-negotiable and no alternative
models were offered or allowed in the workshops. Dissent was not recorded and no
votes on this issue were allowed.

The TSA’s report asserts that the need for
emergency care would be reduced by 30% by providing more care in the community.
However, there is simply no clinical evidence to back this up. In any case
Lewisham Healthcare has already been innovative in working with social services
to provide more care at home and avoid admissions in patients with chronic
illness. These arrangements would not be replicated if acute services were lost. Similarly, Lewisham Healthcare as a
community-integrated Trust has developed networks with GPs, social care and mental health
agencies which would be disrupted if acute services are removed. Fragmentation
of care would result, and quality and safety would be
impaired.

We remain concerned that
modelling of patient flows in the report has been flawed. The flow of patients
and revenue is likely to follow established referral patterns and transport
links, both for emergency and elective services, to King’s College Hospital and
Guy’s and St Thomas Hospitals rather than Woolwich.

Test
4 - The plans do not improve patient choice

Withdrawal of emergency services from
Lewisham residents cannot be perceived as enhancing patient choice. The
report claims that patients can still choose the Lewisham UCC. Although walk-in
patients with obviously minor injuries would retain the Lewisham choice, for a
patient with an undiagnosed complaint needing specialist assessment or possible
admission an urgent care centre staffed by nurses and GPs, would not be a
meaningful choice.

The TSA’s claim that the changes increase
patient choice by one failing trust becoming three separate provider sites is
risible, since the main change is a major hospital closure.

Maternity choice for the large
proportion of high-risk’ pregnancies in Lewisham would be reduced by
the loss of the current co-located obstetric
and midwifery unit at Lewisham.

Local
residents need essential services, provided by a high performing Trust

Emergency services are vital for the
population of Lewisham, which contains some of the most deprived wards in
England. Lewisham Hospital’s new £12 million A&E department opened as
recently as April 2012 in response to the need for expanded services. Our
intensive care unit has excellent standardised mortality rates ([vii]).
Our new birthing centre has high maternal satisfaction. Lewisham Hospital
features in the top 40 hospitals in the CHKS rankings for 4 successive years ([viii]).

Closing
emergency and maternity services in a successful hospital is not only wrong,
and also unnecessary

Destroying a successful
hospital by closing vital services is simply not necessary financially and
would only make a saving of £12.2 million (which was around the cost of
Lewisham’s new emergency department). If nothing is done, South London
Healthcare will have a financial gap by 2015/16 of £75.6 million; however, the
TSA’s own figures (Figure 47 of the final report) predict a financial gap of
just £1.7 million from a
breakeven position if five of the six recommendations are accepted (excluding
recommendation 5, so keeping acute services at Lewisham). Despite Matthew
Kershaw’s statement that no one has offered alternative solutions, Lewisham
Healthcare NHS Trust clearly provide alternative solutions in the Trust’s
expression of interest for working with the Queen Elizabeth Hospital.
These were not pursued by the TSA.

This
has an importance beyond Lewisham

The report is an attempted regional
reconfiguration, tacked onto the statutory regime for an unsustainable
provider, which is being used here for the first time ever. This
reconfiguration is centrally-dictated and does not have the support of the
local CCG. The administrator perversely
recommends downgrading of services at a high-performing and financially-solvent
trust to save a separate, unsustainable provider. It will result in harming a
healthy hospital to save three unhealthy ones, in defiance of local
commissioners. Is this a signal that your government will want to send to the
NHS and the public?